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EHR Interoperability WG

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The HL7 Electronic Health Record (EHR) Interoperability Work Group is an activity of the HL7 EHR Work Group.

Please subscribe to the HL7 EHR Interoperability listserver for meeting announcements, agendas and updates regarding current work.

NOTE: DRAFT documents may be incomplete and are posted for Team review and discourse. Please take care to note their draft (tentative) status if referencing or sharing with others.


HL7 EHR/PHR Standards

System Functionality Standards

Record Interoperability Standards

HL7 EHR Work Group - Reducing Clinician Burden Project

Note that the HL7 EHR WG Reducing Clinician Burden Project now has its own Wiki page:

HL7 RCB Project - Presentations

HL7 RCB Project - Analysis, Derivations and Worksheets

This version of the RCB Analysis Worksheet includes the ONC FINAL "Strategy on Reducing Burden Relating to the Use of Health IT and EHRs". Each of the four ONC Initiatives(I), along with Strategies(S) and Recommendations(R) are inserted within the related RCB topic area and are identified as Ix.Sx.Rx. NOTE also that all reference sources up through #122 have been reviewed and are incorporated in this version. See "References" Tab.

This one page DRAFT outlines key causal factors for clinician burden and is offered for review and comment.

These comments on the DRAFT International Patient Summary were prepared in correspondence with findings of the HL7 RCB Project and clinician burdens associated with patient summary creation, exchange and use, particularly with regard to aspects of information overload, data integrity, patient/provider identity matching, preservation of clinical data context, reconciliation of medications, medication allergies, all allergies, problems/diagnoses and more.

This worksheet shows a typical end-to-end information flow for clinical documentation, starting at the point of origination (authorship) of a health record entry - following with points of update, verification, attestation, exchange (transmit and receipt) - ending at the point where record entry content is accessed/used for subsequent patient care, interventions and decision making.

This graphic asks the question "How Might We Ensure End-to-End Fidelity as We Collect, Share and Use Clinical Documentation?", considering what the author sees/intends and how that corresponds to what the end user sees.

This graphic shows a Clinical Documentation Instance and subsequent clinical and non-clinical flow based on its segments: •provenance, •clinical facts, findings and observations, •order detail, •prior authorization detail, •billing/claims detail, •quality/performance data, •public health data, •administrative data, •finance/cost data, •registry data... Each segment represents a purpose of collection and a corresponding purpose of use, based on stakeholder needs.

This document is part of an initial dialogue between the HL7 RCB Project and the US Centers for Medicare and Medicaid Services (CMS) Office of Burden Reduction and Health Informatics and offers a timeline of HL7 EHR WG standards development activities from 2000 until the present.

These comments were submitted to the Sequoia Project, Data Usability Workgroup, as part of their consideration of characteristics/qualities of health data that make it usable - for particular end uses/end users (e.g., clinicians in clinical practice) and are derived from analysis of the RCB Project.

These comments were submitted to HL7 leadership as part of the ongoing effort to re-envision HL7 and are derived (in part) from analysis of the RCB Project.

HL7 RCB Project - Conversations

Based on our conversation with the AMA, we have drafted a Burden Impact Statement, designed for consideration by HL7 Work Groups and Project Teams as new HL7 Work Items are introduced. This has yet to be formalized and is offered as a DRAFT for review and comment.

HL7 RCB Collaborative Project Candidate - Medication List Management and Reconciliation

The Medication Reconciliation Burden Reduction Focus Team meets most Thursdays at 5PM ET (US). Teleconference access is as noted above. If you are a clinician with medication reconciliation experience, please join us.

HL7 RCB Project - Reducing Clinician Burden "Comment Only" Ballot

This ballot closed on Monday, 14 September 2020.

HL7 RCB Project - White Paper

This White Paper has been released for Project Team review and comment.

HL7 RCB Project - Reducing Burden - Success Stories

Burden Reduction (and other) Initiatives in Response to the COVID-19 Pandemic

"See What We Mean"

HL7 RCB Project - Survey and Responses

HL7 RCB Project - Focus Team Drafts

US Office of National Coordinator for Health Information Technology (ONC) Strategy for Reducing Burden

US Department of Health and Human Services (HHS) Patients over Paperwork Initiative

More RCB Perspectives and Resources

HL7 RCB Project - Reference Sources

RCB Reference Sources (and related links) are available at the RCB Wiki:

US Office of National Coordinator (ONC), Trusted Exchange Framework/Common Agreement (TEFCA)

US Office of National Coordinator (ONC) - 21st Century Cures Act: Interoperability, Information Blocking...

US Office of National Coordinator (ONC) - Interoperability Standards Advisory (ISA)

US Office of National Coordinator (ONC) - Interoperability Forums

US Office of National Coordinator (ONC) - "Record to Rely On" Workshop, 29 November 2016

Leads: Mark Knee JD, Elise Sweeney Anthony JD, Mike Lipinski JD

US Centers for Medicare and Medicaid Services (CMS) - Interoperability and Patient Access...

HL7 FHIR Standard Release 4

FHIR EHR-S Record Lifecycle Event Implementation Guide

FHIR AuditEvent and Provenance Profiles

FHIR Five W's Pattern (Who, What, When, Where, Why)

FHIR Implementer's Safety Check List

Interoperability Assessment

Blockchain for Health/Healthcare (Public Journal)

International Patient Summary (INTERPAS/IPS)

PUBLICATION PACKAGE - Meaningful Use 2015 Edition Functional Profile

Leads: Gary Dickinson, Anneke Goossen, Michael Van Der Zel

Meaningful Use 2015 Edition Functional Profile (of ISO/HL7 10781 EHR-S FM Release 2)

Leads: Gary Dickinson, Mark Janczewski MD, Anneke Goossen

Meaningful Use 2014 Edition Functional Profile (of ISO/HL7 10781 EHR-S FM Release 2)

Leads: Gary Dickinson, Diana Warner, Hetty Kahn, Anneke Goossen

EHR as Legal Record Project

HL7 EHR and Records Management-Evidentiary Support (RM-ES) WGs

Leads: Gary Dickinson, Reed Gelzer MD, Diana Warner

Record Entry Lifecycle Event Metadata using FHIR (Fast Health Interoperable Resources) - Project Now Complete

Lead: Gary Dickinson

Record Lifecycle, Provenance and Vocabulary Alignment - Project Now Complete

Record Lifecycle, Security, Privacy, and Provenance Vocabulary Alignment

Leads: Reed Gelzer, MD, Diana Proud-Madruga


US ONC Standards and Interoperability Framework

2011-2016 Use Case Initiatives - Transitions of Care, Lab Results, Provider Directory, Digital Certificate, et al.

Cross Initiative Work Group - S&I Simplification

ISO/HL7 10781:2017 EHR-S FIM Release-3 2014-Planning

Gary Dickinson, co-chair and Steve Hufnagel PhD, project-facilitator

EHR-S FIM is EHR System Function-and-Information Model, release-3 planned for '2017 joint ISO/HL7-International ballot

EHR-S and PHR-S FIM, Release-3 2012 Prototype

Steve Hufnagel, Facilitator and Gary Dickinson, co-chair


- add conceptual information and data model for each Release 2.0 EHR-S FM function
- make the EHR-S FM easier  to use for architects, analysts and engineers
- verify and validate EHR-S FM Release 2.0
- DSTU demonstration for Service Aware Interoperability Framework (SAIF) 
- Support specific profiles (e.g., WG project DAMS, DIMS, DCMS).






US HITECH Act - EHR Incentive Program - Stage 1 - Final Regulations (2011 Edition)

US HITECH Act - EHR Incentive Program - Stage 2 - Final Regulations (2014 Edition)

US HITECH Act - EHR Incentive Program - Stage 3 - Final Regulations (2015 Edition)

US ONC Final 10 Year Interoperability Roadmap

US ONC Advance Notice of Proposed Rulemaking

Metadata Standards to Support Nationwide Electronic Health Information Exchange

ISO 16223 - Standards Convergence to Promote EHR Interoperability

Key Reference Documents

2009 ANSI HITSP Foundations Framework Simplification Strategy